Part 2: The service scope of CAMHS
Specialist CAMHS services are available to children and young people who have severe, complex and enduring emotional/behavioural/mental health difficulties. Specialist CAMHS services are, for example, not appropriate for children / young people who are experiencing a normal reaction to a significant life event (e.g. a normal bereavement or a normal reaction to parental separation). A good understanding of the service scope and assessment criteria will help clients in getting the right service.
A. Type of problem
1. Severe or life-threatening conditions
- Psychosis
- Risk of suicide or severe self-harm
- Severe depressive episode
- Anorexia Nervosa
2. Conditions leading to severe functional impairment
- Severe Obsessive-Compulsive Disorder (OCD)
- Severe anxiety / phobic / panic disorders / Bipolar Disorder
- Bulimia Nervosa
- Neurodevelopmental Difficulties (NDD)
- Autistic spectrum conditions (ASC) /Autistic Spectrum disorders
- ADHD where there is significant psychiatric co-morbidity
- Tics and Tourette’s
- School refusal where mental health disorder plays a significant role
- Conduct Disorder or Conduct difficulties which co-exist with other disorders and where specific interventions may influence outcome
- Severe and / or complex relationship difficulties leading to significant impairment of functioning and wellbeing
- Gender identity disorders
3. Emotional/behavioral/mental health difficulties in children and young people with learning disabilities.
This includes children and young people with specific as well as mild learning disabilities. The mental health needs of children and young people with more moderate to severe learning disability are provided for by specialist teams. There is a CAMHS Learning Disability Team and Child Disability Team in most of the areas.
4. Emotional difficulties related to and severely complicating physical conditions where treatment will influence the outcome such as:
- Diabetes
- Asthma
- Neurological conditions
- Unexplained pain / somatising disorders
5. Where early intervention is likely to prevent the development of more severe disorder such as :
- Complicated bereavement
- Post-traumatic stress disorder (PTSD)
- Severe attachment difficulties
B. HOW TO DECIDE WHO IS AN APPROPRIATE REFERRAL ?
The CAMHS team will allocate an assessment appointment based on need, judged by:
1. Severity of Symptoms/ difficulties
Specialist CAMHS will accept referrals of children and young people whose symptoms or distress and degree of social and/or functional impairment are severe. The emotional health and wellbeing difficulties need to have a noticeable and substantial impact on a number of areas of functioning: e.g. school, home and social situations.
2. The Duration of the symptoms/difficulties
Usually, the duration of these difficulties should be not less than three months. For severe / life-threatening conditions (see above) and for other conditions where there is severe impairment of functioning, the referral should be made immediately.
Where the child/young person’s symptoms persist beyond this time, and/or they are non-responsive to first line interventions (e.g. school support, community services), i.e. the difficulties are worsening/persisting despite front line interventions being in place e.g. ELSA in school, community parenting support, GP directed self help, they should be referred to CAMHS.
Evidence of recent typical external stressors e.g. family breakdown, bereavement, exams, hospital visits (past or impending) where sufficient time has been allowed for the child to adjust and/or recover with help from immediately available resources
A child/young person should be seen urgently if there is a reported sudden onset of symptoms, symptoms are causing substantial distress or there is probable risk of harm to self or others due to level of difficulty.
3. Severe Mental Health Disorders
Specialist CAMHS will accept referrals where there is a likelihood that the child or young person has a severe mental health disorder.
4. Case Complexity
Specialist CAMHS will accept referrals where there is a high level of case complexity. This might include, for example, multiple risk factors, complex family problems, child protection concerns, such as parental mental health, history of abuse, familyDisruption. Concerns of risk that is ongoing e.g. domestic abuse, physical chastisement, significant substance use, exploitation, risks posed by significant others.
C. HOW TO DECIDE WHO IS NOT AN APPROPRIATE REFERRAL?
In order to improve accessibility for children and young people, the team will find the following not appropriate for referral to specialist CAMHS:
1. Child / Young Person’s Response to Normal Life Events
These are sometimes called “normal adjustment reactions”. Unfortunately, we are unable to provide a service to children and young people whose difficulties are associated with a normal reaction to recent life events (e.g. bereavement, parental separation, physical illness). If intervention is required, these children and young people are usually best helped by counselling, and it is not necessarily appropriate to identify the child/young person with the specialist CAMHS service.
2. Children / Young People Whose Difficulties Occur only at School
Please note that specialist CAMHS does not provide a service for children and young people whose problems are solely related to specific learning or behavioural difficulties within the classroom or other difficulties which occur only at school (e.g. behaviour settled at home; unsettled in school). For these children/young people it is usually more appropriate for educational services to become involved to address the difficulties.
3. Interventions for single symptom presentations
Single symptom such as sleeping difficulties, minor eating problems, toileting issues would not meet CAMHS criteria and should be provided by universal or targeted services (e.g. primary care, local service teams) in the first instance.
